It’s been liberating and eye-opening and sometimes a pain to have all three of my kids in grade school. The benefits of one drop off and not paying for daycare do outweigh the downside of figuring out what to do with the kids when they have days off. Usually, I plan my schedule accordingly, but I still have to fit in the requisite number of shifts for my FTE, which leads to creative scheduling during summer and school breaks.
Over this year’s holiday break, I worked a number of “swing” shifts, 4 p.m. to midnight. My civilian husband works traditional 8 to 5 hours Monday through Friday, but he can be a little flexible too. He would go in to work a little early while I slept in with the kids and would also come home a bit early so that I could get to work by 4 p.m. It struck me during one of these exchanges, as I hurled bits of information that I felt were pertinent for him to successfully parent the kids in my absence that I was “handing off” or “signing out” our children to him. I wondered which of the following standardized handoff templates would be most effective for this purpose.
SBAR
(Molly A/female/age 5 years/17 kg)
Situation: I am going to work. I don’t have to stay overnight.
Background: Molly has smeared her makeup all over the bathroom walls, cut her own hair, and made a potion out of the contents of the refrigerator.
Assessment: Molly is a little bad guy.
Recommendation: Molly needs a 1:1 sitter. Do not let Molly out of your sight.
IPASS
(Charles A/male/age 8 years/35 kg)
Illness severity: Watcher
Patient (progeny) background: Charlie has been tormenting his sisters today, has not been responsive to my interventions and has lost his screentime privileges.
Action items: [ ] Charlie has basketball practice from 6:00-7:15. [ ] He needs to eat dinner before he goes, but I’m not sure what we have.
Situational awareness/contingency planning: If Charlie’s behavior doesn’t improve, you may need to extend his screentime ban. If you can’t find his basketball shoes on the shoe rack, they might be in the back of the minivan.
Synthesis by receiver: Nick: “So practice is at 6?”
ISHAPED
Introduce: Claire is a 12-year-old previously healthy female.
Story: Claire has been lounging around the house, reading, and watching Star Wars movies for days. She becomes irritable and angry when asked to take the dog for a walk or clean her room.
History: Vital signs have been stable; responds to painful stimuli (e.g., requests to do chores); pain score 11.5/10; tolerating soft diet (mac and cheese, PB&J).
Assessment: Post-holiday malaise.
Plan: Out of bed every 4 hours, discharge back to school in 4 days.
Error prevention: At risk for DVTs and pressure ulcers.
Dialogue: Nick: “I don’t see what the problem is as long as she hasn’t been watching The Phantom Menace.”
It is only on the rare occasion that I provide a written handoff tool for my husband. I reserve those for the most complicated and busy shifts, the ones where each child has to be a different place at a different time. Despite leaving a written handoff for him on a recent busy Saturday morning, my 12 year old missed the first half of her basketball game because he didn’t pay attention to the time column. I swallowed the urge to send this error to peer review; I already know what the conclusion would be.
Lisa Sieczkowski is a pediatrician.
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